Workers’ Compensation Claim Questions and Answers

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Workers’ Compensation Claim Questions and Answers
Workers’ Compensation Claim Questions and Answers

If you were recently injured on the job, you’ve probably got more than a few questions running through your mind – Where should I go for treatment? Will I ever be able to work again? How long will it take me to recover? Do I qualify for workers’ compensation?

An injury is scary for many reasons. First and foremost, a serious injury puts your health at risk. Secondly, it can be difficult for injured workers to make a living and support themselves financially – for that reason, many employees apply for workers’ compensation.

What is Workers’ Compensation?

Workers’ compensation is an insurance program that provides benefits to employees who suffer an injury or illness on the job or as a result of their job.

What Qualifies a “Work-Related Injury”?

A work-related injury can mean a number of things – from slipping and falling at work to getting an illness caused by your work environment (such as asbestos exposure in construction workers). You can also be covered if you’re injured while traveling for work.

Why do Workers’ Compensation Claims get Denied?

Unfortunately, insurance agencies look for reasons to deny your claim, which prevents you from getting the benefits you deserve. The most common reasons for a denied claim are:

  • Your injury wasn’t work-related. Falling off a ladder while on a construction site is a pretty straight forward job-related injury. But what if after years of removing asbestos, you develop a lung disease — does that qualify as a work-related injury? While you (or better yet, your lawyer) would argue your condition was caused by the asbestos exposure, your insurance agency will likely argue that it was caused by smoking, an unhealthy lifestyle, or exposure to other harmful chemicals.
  • Your doctor isn’t an approved provider. If you suffer an injury, your first instinct is probably to visit a nearby hospital or your primary care physician, unaware of the fact that not every doctor is qualified to treat patients undergoing a workers’ compensation claim.
  • Your doctor missed deadlines. While undergoing a workers’ comp claim, your priority is getting better — your doctor is responsible for filling out paperwork and sending it to the insurance agency. If your healthcare provider has never worked a workers’ comp claim, they can miss important deadlines and be the cause of your rejected claim.

What to Do After Suffering a Work-Related Injury?
1. Report your accident.

The first thing you should do after sustaining an injury (no matter how big or small) is report it to your boss or HR representative. It’s then their responsibility to write a detailed account of the incident, including what happened, when it happened, or if witnesses were present during the time of the accident. This is important for the company’s records as well as the insurance agency’s.

2. Seek (the right) medical care.

Your local physician may be able to care for your health, but he or she is likely unaware of the workers’ compensation process. The doctors at Bloomfield and Plymouth Urgent Care are trained to treat your injury and file the paperwork you need correctly and on time.

3. Track all of your medical expenses.

Workers’ compensation can potentially cover more than just medications. It can also cover medical equipment (wheelchair, crutches, assistive canes, etc.) and medicinal treatments (massage therapy, physical therapy, etc.). It’s important that you track all of your medical expenses, even if you’re not sure they can be covered.

How Your Doctor Will Affect The Outcome of Your Workers’ Comp Claim
Diagnosis and Treatment

Naturally, your healthcare provider will be in charge of all decisions regarding your diagnosis, treatment, and recovery. Even if you have a workers’ compensation claim pending, their primary goal should be your health.

Determining Your Limitations

Your doctor will also be responsible for telling your employer and insurance agency what you can and can’t do. If your injury was relatively minor, they may suggest you go back to work but not lift heavy things. If they determine your injury was severe, they can suggest you not be allowed to return to work at all and should, therefore, receive full benefits.

If you want to know more, call us for more information or schedule an appointment online! We serve patients from Plymouth MI, Bloomfield Hills MI, Livonia MI, Novi MI, Worden MI, Canton MI, Southfield MI, Troy MI, and Farmington Hills MI.